Fertility preservation is possible if suitable techniques are started early, before chemotherapy or radiotherapy for cancer patients. For men, sperm cryopreservation is effective but hormonal suppression is not recommended. For women, embryo cryopreservation is established while oocyte cryopreservation is becoming a good option. Ovarian tissue cryopreservation and transplantation is experimental. Pregnancy after breast cancer treatment does not imply a worse prognosis. Chemotherapy during pregnancy can be introduced for hematologic malignancies. Fertility preservation should be considered for cancer patients before gonadotoxic treatment and for others diseases requiring such treatment.

1. Fertility Preservation
Where Do We Stand?
Dr. Mamdouh Sabry
MD. Ain Shams, Ph.D. France
Consultant Ob. & Gyn.
EL Mataria Teaching Hospital, Nasser Institute
Cairo, Egypt

2. • During the 20th week of i.u. life oocytes
reach 7 millions, reaching 2 millions at
birth and 200000 at puberty.
• Acceleration of atresia is remarkable at
age 37, reaching 1000 at menopause.
• As number decreases, age 35 or more ,
the rate of abnormal embryos increases
with increase rate of miscarriage.
• The introduction of gonadotoxic treatment
in malignancy, prior to BMT, and other
conditions ends in male and female
infertility.

3. Why To Preserve Fertility?
The increase In :
• Rate of unmarried females age > 30 years.
• Malignancy among children and during age
reproductive period ( EBC )
• Technology for early detection & treatment.
• Survivors from cancer.
• Use of gonadotoxic therapy before BMT.
• Awareness and diagnosis of diseases
leading to premature menopause.

4. Data Collection
 Data from ASCO (am. Soc. Cl. On.)
 Up to date.com
 Evaluation of 65 publications, obser., cohort, case rep.
and few randomized clinical trials.
 Medline.
 Cochrane Collaboration Library.
 Our experience in N. In. , Hema. On. Gp., Ped. On. Gp.

5. Is It Possible ?
• FERTILITY PRESERVATION IS
POSSIBLE, BUT WE HAVE TO
START SUITABLE TECHNIQUE AS
EARLY AS POSSIBLE AFTER
DIAGNOSIS AND BEFORE
EXPOSURE TO CHEMO- OR
RADIOTHERAPY IN CANCER
PATIENTS……

6. Fertility Preservation for Men
• Sperm cryopreservation, effective, sample has to be
divided.
• Hormonal gonadal suppression not recommended !!??
• Testicular tissue preservation and re-implantation or
grafting of testicular tissue is performed as clinical trials
or approved experimental protocol.
• Post chemotherapy sperm collection holds high risk of
genetic or morphologic sperm damage ( 3 months )

7. Fertility Preservation for Women
• Embryo cryopreservation is an established routine method.
• Oocyte cryopreservation is considered a good option
recently in experienced centers with application of flexible
protocols for ova collection and induction with AI. Specially
for estrogen sensitive breast or gynecol. malignancy .
• Oophoropexy before pelvic radiation >> technique not
always successful due to many factors.
• Ovarian suppression >> insufficient evidence on its
effectiveness and ineffectiveness!!!
• Ovarian tissue cryopreservation and transplantation>> only
method in children>> experimental and performed only in
centers with good experience.

9. Pregnancy and Malignancy
• Contemporary research established that, breast
cancer does not imply a worse prognosis in
women seeking pregnancy after ttt.
• Delay few weeks (1st trimester) not affect
outcome, tamoxifen and ch. Therapy are given
in 2nd trimester (Int. cancer in pregnancy study,
German breast gp., Ann. Oncol. Jun. 2013,
RCOG guidelines 2011)
• Chemotherapy can be introduced during
pregnancy in hematologic malignancy.

10. Conclusion
• Does chemotherapy and pelvic radiation
affect gonadal function? YES.
• Does gonadal suppression preserve their
function? May be ?!.
• Is pregnancy safe after Breast cancer ttt?
YES.
• Does pregnancy worsen hematologic or
breast cancer prognosis? NO.
• Cancer breast might be preventable? YES

11. Fertility preservation
Indications:
• Cancer patients before gonadotoxic
treatment
• Other diseases before gonadotoxic
treatment ( Bone marrow transplantation )
• Young patients with Turner syndrome,
Fragile X chromosome (FMR 1),
Galactosemia
• Women in mid-thirties and not yet married.